1. Acute Care for Elderly ACE (We certainly think we are)

2. Aim Aim: To improve the care for over 85 year old acute geriatric patients by implementing an Acute Care for the Elderly model, as evidenced by – Decrease in Acute-Rehab LOS from 25 - 20 Days Decrease in ACE LOS from 8.5 - 7 Days Decrease in readmission rate from 6% - 4% Decrease in step down of care rate from 14% - 8%

3. Overview of ACE What – Geriatrician led, comprehensive MDT care for acute elderly focusing on a sustainable return home Who – >85yo, acute admission, excludes specialist conditions, frail, complex needs How – Intensive MDT model, early screening, early and preventative rehab, comprehensive geriatric assessment, removal of a transition of care for those requiring rehab Why – Vulnerable patient group, higher readmissions, high rate of step down in care, unmet need

4. Challenges/Learnings Defining an “ACE” patient  Refining our acceptance criteria Getting ACE patients to the ward  Education  Operational shift  Culture change Understanding what we had changed and if our baseline was still relevant

5. Review of Baseline ACE – 25% of original target group >85, Acute, excluding specialist conditions >85, Acute, excludes specialist care >75, Acute, excludes specialist care 50 patients per month 90 patients per month 150 patients per month 300 patients per month

6. Successes JaM tool – Quick identification of patients at risk of step down in care  Aim to get high value patients Admission screen  Facilitates combined MDT approach leading to combined care planning 9am Huddle  Improves regular ward communication and a team based approach

7. Summary Data to Date BaselineTarget5 Month Average 7 day Re- admission rate 6%4%2.6% Rate of step down of care 14%8%8.8% Acute ALOS7 days 8.5 days Combined ALOS – ACE/AT&R 24.9 days20 days15.9 days

8. Acute to Rehab Journey >85’s

9. Gen Med 9.7 days AT&R 15.2 days Gen Med 7.9 days AT&R 9 days ACE 6.9 days AT&R 9 days Baseline 24.9 days Post ACE 16.9 days

10. Mrs W – Chest infection, delirium, dementia, pressure area, reduced mobility Screening showed cognition declined, variable mobility, poor food intake Cared for by daughter – burn out, not engaged and didn’t have the skills Meeting with daughter/CN/SW Day care and respite arranged Daughter educated re pressure care, feeding and spent time with PT/Nursing to learn cares D/C home Case Study